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Organization

GUARDIAN RESIDENTIAL SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN THOMAS REDD III (CEO)
(804) 359-0613
Entity
Organization

Contact information

Practice address
1510 WILLOW LAWN DR, SUITE 10, RICHMOND, VA 23230-3429
(804) 359-0613
(804) 359-0614
Mailing address
1510 WILLOW LAWN DR, SUITE 10, RICHMOND, VA 23230-3429
(804) 359-0613
(804) 359-0614

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
1523-01-001
VA
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
1523-01-001
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1523-01-001
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
VA
Enumeration date
09/28/2009
Last updated
09/28/2009
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